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Multivariate Base Rates of Low Scores and Reliable Decline on ImPACT in Healthy Collegiate Athletes Using CARE Consortium Norms

Published online by Cambridge University Press:  05 July 2019

Zac M. Houck ,
Breton M. Asken ,
Russell M. Bauer ,
Anthony P. Kontos ,
Michael A. McCrea ,
Thomas W. McAllister ,
Steven P. Broglio ,
James R. Clugston  and
Care Consortium Investigators
Zac M. Houck*
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA
Breton M. Asken
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
Russell M. Bauer
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA
Anthony P. Kontos
Affiliation:
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
Michael A. McCrea
Affiliation:
Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 53266, USA
Thomas W. McAllister
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
Steven P. Broglio
Affiliation:
Department of Kinesiology, NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Michigan 48109, USA
James R. Clugston
Affiliation:
Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida 32610, USA
Care Consortium Investigators
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 53266, USA Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA Department of Kinesiology, NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Michigan 48109, USA Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida 32610, USA
*
Correspondence and reprint requests to: Zac M. Houck, Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA. E-mail: zhouck@phhp.ufl.edu
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Abstract

Objectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at <25th percentile (Low Average), <10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses. Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors. Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.

Keywords

Cognitive functioningBaseline testingCAREReliable changeRaceConcussion
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 9 , October 2019 , pp. 961 - 971
Copyright
Copyright © INS. Published by Cambridge University Press, 2019. 

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